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Triple-bundle ACL grafts evaluated by second-look arthroscopy

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the morphology of transplanted triple-bundle anterior cruciate ligament (ACL) grafts by second-look arthroscopy.

Methods

The subjects were 41 patients with a mean age of 25.5 ± 8.5 years who underwent second-look arthroscopy at between 6 and 22 months after the anatomical triple-bundle ACL reconstruction using semitendinosus tendon autograft. Lachman test was negative in 38 knees and mildly positive with a firm endpoint in 3 knees. Arthroscopic evaluation of grafts was performed for the anteromedial graft (AM), the intermediate graft (IM), and the posterolateral graft (PL), focusing on tension and graft damage.

Results

All grafts showed “fan-out” shape approaching the tibial attachment, which looked closer to the natural ACL compared to the double-bundle grafts. As to graft tension, 93% of AM, 90% of IM, and 88% of PL grafts were evaluated as taut, respectively. As to graft damage, there was no apparent rupture in the AM and IM grafts, while complete or substantial rupture was observed in 10% of PL grafts around the femoral tunnel aperture. The incidence of graft rupture in PL grafts was significantly greater than those in the AM and IM grafts. As to synovial coverage, 76% of AM, 78% of IM, and 59% of PL grafts were evaluated as “Good,” while 41% of PL grafts were not fully covered with synovium. All of the synovial defects were observed around the femoral tunnel aperture.

Conclusion

The morphology of the triple-bundle grafts resembled that of the natural ACL, while complete or substantial rupture was observed in 10% of the PL grafts.

Level of evidence

Study of case series with no comparison group, Level IV.

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Authors and Affiliations

  1. Department of Sports Orthopaedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 583-8555, Japan

    Yoshinari Tanaka & Shuji Horibe

  2. Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Sakai, Japan

    Konsei Shino

  3. Institute for Medical Science in Sports, Osaka Health Science University, Kumatori, Japan

    Norimasa Nakamura

  4. Department of Sports Orthopaedics, Yukioka Hospital, Osaka, Japan

    Shigeto Nakagawa

  5. Department of Orthopaedics, Sapporo Medical University, Sapporo, Japan

    Hidenori Otsubo & Tomoyuki Suzuki

  6. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan

    Tatsuo Mae & Ken Nakata

Authors
  1. Yoshinari Tanaka
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  2. Konsei Shino
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  3. Shuji Horibe
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  4. Norimasa Nakamura
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  5. Shigeto Nakagawa
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  6. Tatsuo Mae
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  7. Hidenori Otsubo
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  8. Tomoyuki Suzuki
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  9. Ken Nakata
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Corresponding author

Correspondence to Yoshinari Tanaka.

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Tanaka, Y., Shino, K., Horibe, S. et al. Triple-bundle ACL grafts evaluated by second-look arthroscopy. Knee Surg Sports Traumatol Arthrosc 20, 95–101 (2012). https://doi.org/10.1007/s00167-011-1551-8

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  • DOI: https://doi.org/10.1007/s00167-011-1551-8

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